1. A health care professional is caring for a patient who is about to begin taking ethacrynic acid (Edecrin) to treat heart failure. The health care professional should tell the patient to report which of the following indications of a potentially serious adverse reaction?
A) SOB
B) hearing loss
C) swelling in the legs
D) blurred vision

*B) hearing loss*

Rationale: Ethacrynic acid, a high-ceiling diuretic similar in actions and effects of furosemide (Lasix), can cause ototoxicity, which can lead to permanent hearing loss. While hearing loss is transient with furosemide, it is sometimes permanent with ethacrynic acid.

2. A health care professional should question the use of nifedipine (Procardia) for a patient who has a history of which of the following?
A) bradycardia
B) liver disease
C) unstable angina pectoris
D) second-degree AV block

3. A health care professional is caring for a patient who is about to begin taking simvastatin (Zocro) to treat hypercholesterolemia. The health care professional should tell the patient to report which of the following indications of a serious adverse reaction that could warrant stopping drug therapy?
A) bronchoconstriction
B) muscle pain
C) lip numbness
D) somnolence

*B) muscle pain*

Rationale: Simvastatin, an HMG-CoA reductase inhibitor (Statin), can cause myopathy or pain in muscles and joints that can progress to rhabdomyolysis. With this rare but serious adverse effect, muscle protein breaks down and its excretion causes kidney damage

4. A health care professional is caring for a patient who is about to begin captopril (Capoten) therapy to treat hypertension. When talking with the patient about taking the drug, the health care professional should tell her to report which of the following adverse effects because they can indicate a need to stop drug therapy? (Select all that apply)
A) rash
B) distorted taste
C) swelling of the tongue
D) photosensitivity
E) dry cough

*A, B, C, E*

5. A health care professional is caring for a patient who is about to begin aliskiren (Tekturna) to treat HTN. The health care professional should monitor the patient for which of the following adverse effects of the drug? (Select all that apply)
A) hyperkalemia
B) throat swelling
C) constipation
D) cough
E) joint pain

*A, B, D*

6. A health care professional is reviewing the history of a patient who is about to begin furosemide (Lasix) therapy to treat HTN. Which of the following drugs that the patient takes should alert the health care professional to take further action?
A) Lithium (Lithobid) for bipolar disorder
B) Phenytoin (Dilantin) for seizure disorder
C) Erythromycin (Erythrocin) for bronchitis
D) Warfarin (Coumadin) to prevent blood clots

*A) Lithium (Lithobid) for bipolar disorder*

Rationale: Furosemide, a high-ceiling loop diuretic, increases sodium loss and can cause reabsorption of lithium, a mood stabilizer. This puts patients taking both drugs at increased risk for lithium toxicity

7. A health care professional is caring for a patient who has moderate to severe hypertension and is about to begin hydralazine therapy. The health care professional should monitor the patient for which of the following adverse reactions to the drug?
A) A flu-like syndrome
B) Extrapyramidal symptom
C) A lupus-like syndrome
D) Hypertensive crisis

*C) A lupus-like syndrome*

Rationale: A systemic lupus erythematosus-like syndrome can develop with hydralazine, a direct-acting vasodilator. Manifestations include facial rash, joint pain, fever, nephritis, and pericarditis. High Doses make it more likely. Fluid retention and edema can also develop.

8. When talking with a patient about taking amiodarone (Cordarone) to treat aterial fibrillation, which of the following should the health care professional tell the patient to avoid?
A) Grapefruit juice
B) Milk
C) Foods high in vitamin K
D) NSAIDs

*A) Grapefruit juice*

Rationale: Grapefruit juice, particularly in large amounts, can cause toxicity of potassium channel blockers such as amiodarone

9. While talking with a patient about drug therapy options for hypertension, the provider notes that the patient also has some manifestations of depression that require treatment. Which of the following antihypertensive drugs is inappropriate for the patient?
a. Reserpine
b. Captopril (Capoten)
c. Hydralazine
d. Epleerenone (Inspra)

*A) Reserpine*

Rationale: Severe depression and an increased risk for suicide are adverse effects of adrenergic neuron blockers, such as reserpine. These effects can persist after patients stop taking these drugs. These adverse effects develop because of the depletion of serotonin and norepinephrine.

10. A provider is considering the various drug therapy options for treating a patient’s cardiac dysrhythmia. He should be aware that which of the following antidysrhytmic drugs is appropriate only for short-term use because of its severe adverse effects with long-term use?
a. Quinidine
b. Procainamide
c. Nitroglycerin
d. Verapamil (Calan)

*B) Procainamide*

Rationale: Procainamide, a sodium channel blocker and a broad-spectrum antidysrhythmics, is a poor choice for long-term control of dysrhythmias because of its risk for serious adverse effects, including cardiotoxicity and arterial embolism.

11. A health care professional should question the use of dobutamine for a patient who is receiving which of the following types of drugs? (Select all that apply)
a. ACE inhibitor
b. MAOI
c. General anesthetic
d. Tricyclic antidepressant
e. Beta blocker

*B, C, D, E*

12. A health care professional is caring for a patient who is about to begin taking losartan (Cozaar) to treat HTN. The health care professional should tell the patient to report which of the following indications of an adverse reaction to the drug?
a. Facial edema
b. Sleepiness
c. Peripheral edema
d. Constipation

*A) Facial Edema*

Rationale: Losartan, an angiotensin II receptor blocker, can cause angioedema, often manifesting as redness and swelling around the eyes and lips. Patients who develop this adverse effect should stop taking the drug and seek medical attention

13. A health care professional is caring for a patient who is about to begin taking verapamil (Calan) to treat atrial fibrillation. The health care professional should tell the patient to avoid grapefruit juice while taking verapamil because it can cause
a. Tachycardia
b. Dehydration
c. Diarrhea
d. Hypotension

*D) Hypotension*

Rationale: Large amounts of grapefruit juice increase blood levels of verapamil by inhibiting its metabolism. The excess amount of drug can intensify otherwise therapeutic effects like hypotension, causing serious risks for syncope and dizziness

14. While talking with a patient about taking eplerenone (Inspra) to treat HTN, the health care professional should include which of the following instructions?
a. Avoid drinking grapefruit juice
b. Use sunscreen and protective clothing
c. Avoid the use of salt substitutes
d. Stop taking the drug if dizziness occurs

*C) Avoid the use of salt substitutes*

Rationale: Eplerenone, an aldosterone antagonist, can cause hyperkalemia. Many salt substitutes contain significant amounts of potassium. Patients who take the drug should not use salt substitutes that contain potassium.

15. A health care professional should question the use of milrinone (Primacor) for a patient who currently has which of the following?
a. Acute MI
b. Peripheral vascular disease
c. Ulcerative colitis
d. Ventricular tachycardia

*A) Acute MI*

Rationale: Milrinone, a phosphodiesterase inhibitor is contraindicated for patients who have had an allergic reaction to phosphodiesterase inhibitors and for patients who have an acute MI and aortic or pulmonary valve disorders

16. A patient who takes carvedilol (Coreg) for HTN is about to begin taking an oral antidiabetics drug to manage newly diagnosed type 2 diabetes mellitus. The health care professional should make sure the primary care provider is aware that the patient is at increased risk for which of the following if she takes both drugs?
a. Hyperglycemia
b. Bradycardia
c. Hypotension
d. Hypoglycemia

*D) Hypoglycemia*

Rationale: Two factors increase the patient’s risk for hypoglycemia. Alpha/beta blockers, such as carvedilol, potentiate the hypoglycemia effects of insulin and oral hypoglycemia drugs. Also, carvedilol can mask tachycardia in a patient who has hypoglycemia. Using carvedilol with patients who have diabetes mellitus requires caution

17. A healthy care professional is about to administer atenolol (Tenormin) to a patient who has HTN. Which of the following assessments should the health care professional perform prior to giving the patient the drug?
a. Respiratory rate
b. LOC
c. Serum glucose
d. Apical pulse

18. A health care professional is caring for a patient who is about to begin taking propranolol (Inderal) to treat tachydysrhythmia. The health care professional should caution the patient about taking which of the following types of OTC drugs?
a. Antihistamines
b. Potassium supplements
c. NSAIDs
d. Antacids

*D) Antacids*

Rationale: Antacids and vitamin C can decrease the absorption of propranolol, a beta adrenergic blocker. Patients should avoid taking these OTC preparations and discuss appropriate alternatives with their primary care provider.

19. A health care professional is assessing a patient following the administration of nifedipine (Procardia). Recognizing the adverse effects of nifedipine, the health care professional should be prepared to administer which of the following drugs?
a. Prazosin (Minipress)
b. Doxazosin (Cardura)
c. Propranolol (Inderal)
d. Enalapril (Vasotec)

20. While talking with a patient about taking clonidine (Catapres) to treat HTN, the health care professional should explain that discontinuing clonidine therapy abruptly can result in which of the following adverse effects?
a. Constipation
b. Hypertension
c. Drowsiness
d. Dry mouth

*B) Hypertension*

Rationale: Abruptly discontinuing clonidine, a centrally acting alpha 2 agonist, can cause rebound hypertension. The drug’s target receptors are in the CNS. By stimulating these receptors, sympathetic outflow to the peripheral blood vessels decreases. Thus, the blood vessels dilate and the heart rate slows. Stopping drug therapy causes rebound outflow from the sympathetic nervous system and a sudden and significant rise in blood pressure that can lead to hypertensive crisis

21. The health care professional is caring for a patient who has a glomerular filtration rate of 10mL/min and a reduced urine output. The health care professional should question the use of hydrochlorothiazide for the patient because of which of the following characteristics of the drug?
a. The drug can cause hypoglycemia in patients who have a low urine output
b. The drug does not reduce blood pressure for patients who have a low urine output
c. The drug can increase the risk of pulmonary edema for patients who have renal insufficiency
d. The drug dose not promote diuresis for patients who have renal insufficiency

*D) The drug dose not promote diuresis for patients who have a renal insufficiency*

Rationale: Adequate kidney function is essential for hydrochlorothiazide, a thiazide diuretic, to promote urine production and excretion effectively

22. A patient who is taking digoxin (Lanoxin) develops ECG changes and other manifestations that indicate severe digoxin toxicity. Which of the following drugs should the health care professional have available to treat this complication?
a. Acetylcysteine (Acetadote)
b. Flumazenil (Mazicon)
c. Fab antibody fragments (Digibind)
d. Deferoxamine (Desferal)

*C) Fab antibody fragments (Digibind)*

Rationale: Fab antibody fragments, also called digoxin immune Fab, binds to digoxin and blocks its action. The health care professional should prepare to administer this antidote IV to patients who have severe dixogin toxicity

23. A health care professional is caring for a patient who is about to begin takin gemfibrozil (Lopid) to treat hypercholesterolemia. Which of the following instructions should the health care professional include when talking with the patient about the drug? (Select all that apply)
a. Take the drug with food
b. Report any new intolerance to fried foods
c. Report muscle tenderness
d. Expect periodic liver function testing
e. Take the drug once a day

*B, C, D,*

24. A health care professional is caring for a patient who is about to begin using transdermal nitroglycerin (Nitro-dur) to treat angina pectoris. When talking with the patient about the drug, the health care professional should include which of the following instructions? (select all that apply)
a. Apply a new patch at the onset of angina pain
b. Apply the patch to dry skin and cover the area with plastic wrap
c. Apply the patch to a hairless area and rotate sites
d. Apply a new patch each morning
e. Remove patches for 10-12 hr daily

*C, D, E*

25. A health care professional is caring for a patient who is taking spironolactone (Aldactone) to treat HTN. Which of the following lab values should alert the health care professional to take further action?
a. Serum sodium level of 140 mEq/L
b. Serum potassium level of 5.2 mEq/L
c. Serum chloride level of 100 mEq/L
d. Serum magnesium level of 1.9 mEq/L

*B) Serum potassium level of 5.2 mEq.L*

Rationale: Spironolactone, a diuretic and an aldosterone antagonist, can cause hyperkalemia and put patients at risk for cardiac dysrhythmias. This level exceeds the expected reference range of 3.5-5.0 mEq/L and warrants immediate intervention

A nurse is planning care for a client who is receiving furosemide (Lasix) IV for peripheral edema. Which of the following should the nurse include in the plan of care? (Select all that apply)
A) Assess for tinnitus
B) Report urine output of 50 mL/hr
C) Monitor serum potassium levels
D) Elevate the HOB slowly before ambulation
E) Recommend eating a banana daily

*A, C, D, E*

A nurse is providing information to a client who has a new prescription for hydrochlorothiazide (Hydrodiruil). Which of the following information should the nurse include?
A) Take the medication with food
B) Plan to take the medication at bedtime
C) Expect increased swelling of the ankles
D) Fluid intake should be limited in the morning

*A) Take the medication with food*

Rationale: the client should take hydrochlorothiazide with or after meals to prevent GI upset

A nurse is monitoring a client who is receiving spironolactone (Adlactone). Which of the following findings should the nurse report to the provider?
A) Serum sodium 148 mEq/L
B) Urine output of 120 mL in 4 hr
C) Serum potassium 5.2 mEq/L
D) Blood pressure 140/90 mm Hg

*C) Serum potassium 5.2 mEq/L*

Serum potassium of 5.2 mEq/L indicates hyperkalemia. Because spironolactone causes potassium retention, the nurse should withhold the medication and notify the provider

A client who has increased intracranial pressure is receiving mannitol (Osmitrol). Which of the following findings should the nurse report to the provider?
A) Blood glucose 150 mg/dL
B) Urine output 40 mL/hr
C) Dyspnea
D) Headache

*C) Dyspnea*

Rationale: Dyspnea can indicate heart failure, an adverse effect of mannitol. The nurse should stop the medication and notify the provider

A nurse is reviewing a client’s medication history and notes that the client is taking digoxin (Lanoxin), an antihypertensive medication, and NSAIDs. The client has a new prescription of torsemide (Demadex). The nurse should plan to monitor for which of the following medication interactions? (Select all that apply)
A) Decrease in serum digoxin level
B) Hypokalemia
C) Hypotension
D) Low urine output
E) Ventricular dysrhythmias

*B, C, D, E*

A nurse is reviewing the health record of a client who is starting propranolol (Inderal) to treat hypertension. Which of the following conditions is a contraindication for taking propranolol?
A) Asthma
B) Diabetes
C) Angina
D) Tachycardia

*A) Asthma*

Rationale: Propranolol is a nonselective beta-adrenergic blocker that blocks both beta1 and beta2 receptors. Blockade of beta2 receptors in the lungs causes bronchoconstriction, so it is contraindicated in clients who have asthma

A nurse is teaching a client who is starting verapamil (Calan) to control hypertension. Which of the following should the nurse include in the teaching?
A) increase the amount of dietary fiber
B) Drink grapefruit juice daily to increase Vitamin C intake
C) Decrease the amount of calcium in the diet
D) Withhold food for 1 hr after the medication is taken

A nurse is caring for a client who is starting captopril (Capoten) for hypertension. For which of the following adverse effects should the nurse monitor the client?
A) Hypokalemia
B) Hypernatremia
C) Neutropenia
D) Anemia

*C) Neutropenia*

Rationale: Neutropenia is a serious adverse effect that can occur in clients taking an ACE inhibitor. The nurse should monitor the client’s CBC and teach the client to report signs of infection to the provider.

A nurse is planning to administer a first dose of captopril (Capoten) to a hospitalized client who has hypertension. Which of the following medications can intensify early adverse effects of captopril? (select all that apply)
A) Simvastatin (Zocor)
B) Hydrochlorothiazide (HydroDIURIL)
C) Phenytoin (Dilantin)
D) Clonidine (Catapres)
E) Aliskiren (Tekturna)

*B, D, E*

A nurse in a provider’s office is monitoring serum electrolytes for four older adult clients who take digoxin (Lanoxin) and furosemide (Lasix). Which of the following electrolyte values puts a client at risk for digoxin toxicity?
A) Calcium 9.2 mg/dL
B) Calcium 10.3 mg/dL
C) Potassium 3.4 mEq/L
D) Potassium 4.8 mEq/L

*C) Potassium 3.4 mEq/L*

Rationale: A potassium of 3.4 mEq/L is below the normal range and puts a client at risk for digoxin toxicity. A low potassium can cause fatal dysrhythmias, especially in older clients who take digoxin. The nurse should notify the provider, who may prescribe a potassium supplement or a potassium-sparing diuretic for the client

A nurse is caring for an older adult client who has a new prescription for digoxin and takes multiple other medications. Concurrent use of which of the following medications places the client at risk for digoxin toxicity?
A) Phenytoin (Dilantin)
B) Verapamil (Calan)
C) Warfarin (Coumadin)
D) Aluminum hydroxide (Amphojel)

*B) Verapamil (Calan)*

Rationale: Verpamil, a calcium-channel blocker, can increase digoxin levels. If these medications are given concurrently, the digoxin dosage may need to be decreased and the nurse should monitor digoxin levels carefully

A nurse is administering a dopamine infusion at a moderate dose to a client who has severe heart failure. Which of the is an expected effect?
A) Lowered heart rate
B) Increased myocardial contractility
C) Decreased conduction through the AV node
D) Vasoconstriction of renal blood vessels

*B) Increased myocardial contractility*

Rationale: The nurse should expect dopamine to cause increased myocardial contractility, which also increases cardiac output. This occurs with the stimulation of beta1 receptors and is a positive inotropic effect of dopamine when it is administered at a moderate dose

A nurse is providing teaching to a client who has a new prescription for digoxin (Lanoxin). Which of the following may indicate digoxin toxicity and should be reported to the provider? (Select all that apply)
A) Fatigue
B) Constipation
C) Anorexia
D) Rash
E) Diplopia

*A, C, E*

The nurse is monitoring the digoxin level for a client who has been taking a daily dose of digoxin for 1 month. The digoxin level is 0.25 ng/mL. The nurse should notify the provider and anticipate which of the following?
A) An increase in the client’s digoxin dose
B) A decrease in the client’s digoxin dose
C) No change in the client’s digoxin dose
D) Discontinuation of the client’s digoxin prescription

*A) An increase in the client’s digoxin dose*

Rationale: The client’s digoxin level is below the therapeutic range. If the client’s clinical findings correlate with the client’s digoxin level, the nurse can expect an increase in the client’s digoxin dose

A nurse is teaching a client who has angina pectoris and is learning how to treat acute anginal attacks. The clients asks, “What is my next step if I take one tablet, wait 5 minutes, but still have anginal pain?” Which of the following replies by the nurse is appropriate?
A) “Take two tablets at the same time and then call 911.”
B) “Call 911 and take a second sublingual tablet.”
C) “Take a sustained-release nitroglycerin capsule rather than a sublingual tablet and wait 5 more minutes before calling 911.”
D) “Wait another 5 minutes before taking a second sublingual tablet”

*B) “Call 911 and take a second sublingual tablet.”*

Rationale: The next step is to call 911 and then take a second sublingual tablet. If the first tablet does not work, the client may be having an MI, so should call for emergency care. The client may take a third tablet if the second one has not relieved the pain after waiting an additional 5 minutes

A nurse is teaching a client who is prescribed nitroglycerin (Nitro-Dur) transdermal patch for angina pectoris. Which of the following instructions should the nurse give the client?
A) Remove the patch each evening and replace it with a new patch in the morning
B) Cut each patch in half if angina attacks are under control
C) Take the nitroglycerin patch temporarily for 30 min if a headache occurs
D) Change the patch every 48 hr right after the first meal of the day

* A) Remove the patch each evening and replace it with a new patch in the morning*

Rationale: in order to prevent tolerance to the nitroglycerin, the client should remove the patch for 10-12 hr during each 24 hr period

A nurse is taking a medication history from a client who has angina and is to begin taking ranolazine (Ranexa). The nurse should report which of the following medications in the client’s history that may interact with ranolazine? (Select all that apply)
A) Digoxin (Lanoxin)
B) Simvastatin (Zocor)
C) Verapamil (Calan)
D) Amlodipine (Norvasc)
E) Nitroglycerin transderm patch (Nitro-Dur)

*A, B, C,*

A nurse is teaching a client who has angina how to use nitroglycerin transdermal ointment. Which of the following instructions by the nurse is appropriate?
A) “Spread the ointment onto a premarked paper using an applicator.”
B) “Rub the ointment directly into your skin until it is no longer visible”
C) “Cover the applied ointment with a clean gauze pad.”
D) “Apply the ointment to the same skin area each time.”

*A) “Spread the ointment onto a premarked paper using an applicator.”*

Rationale: the client should use the applicator that comes with the ointment to measure the correct dose and then spread the ointment onto the premarked paper before applying the ointment-covered paper to the skin

A nurse is caring for a client who took amiodarone (Potassium channel blocker) for 2 months before it was discontinued due to toxicity. Which of the following should guide the nurse when assessing the client for toxicity to amiodatone?
A) Visual impairment resolves when the medication is withdrawn
B) Ototoxicity is irreversible
C) Lung damage continues after medication is stopped
D) Myopathy is a common manifestation of toxicity

*C) Lung damage continues after medication is stopped*

Rationale: Because this medication has such a long half-life, indications of lung damage may continue for months following discontinuation of amiodarone. Findings the nurse should assess for include cough, chest pain, and SOB

A nurse is caring for four clients who are each taking digoxin (Lanoxin). The client who is taking which of the following medications concurrently is at risk for digoxin toxicity?
A) Procainamide (Pronestyl) for premature ventricular contractions
B) Ranitidine (Zantac) for peptic ulcer disease
C) Phenytoin (Dilantin) for a seizure disorder
D) Amiodarone (Cordarone) for ventricular dysrhythmias

A nurse is preparing to administer proprannolol (Inderal) to a hospitalized client who has a dysrhythmia. Which of the following nursing actions should the nurse plan to take while the client is receiving propranolol?
A) Hold propranolol for an apical pulse greater than 100/min
B) Administer propranolol to increase the client’s BP
C) Assist the client when she sits up or stands after taking this medication
D) Check for hypokalemia frequently due to the risk for propranolol toxicity

*C) assist the client when she sits up or stands after taking this medication*

Rationale: Propranolol may cause orthostatic hypotension, so it is important assess for dizziness during ambulation or when moving to a sitting position

A nurse is providing teaching to a client who is starting simvastatin (Zocor). Which of the following should the nurse include in the teaching?
A) Take this medication in the evening
B) Change position slowly when rising from a chair
C) Maintain a steady intake of green leafy vegetables
D) Consume no more than 1 L of fluid/day

*A) Take this medication in the evening*

Rationale: The client should take simvastatin in the evening because nighttime is when the most cholesterol is synthesized in the body. Taking statin medications in the evening increases medication effectiveness.

A nurse is collecting data from a client who is taking gemfibrozil (Lopid). Which of the following assessment findings is an adverse reaction to the medication?
A) Mental status changes
B) Tremor
C) Jaundice
D) Pneumonia

*C) Jaundice*

Rationale: Jaundice, anorexia, and upper abdominal discomfort may be findings in liver impairment, which may occur in clients taking gemfibrozil

A nurse is completing a nursing history for a client who currently takes simvastatin (Zocor). The provider recommends adding ezetimibe to the client’s medications. Which of the following disorders is a contraindication to adding ezetimibe (Zetia) to the client’s medications?
A) History of severe constipation
B) History of hypertension
C) Active hepatitis C
D) Type II Diabetes mellitus

*C) Active hepatitis C*

Rationale: Ezetimibe is contraindicated in clients who have an active moderate-to-severe liver disorder, especially if the client is already taking a statin, such as simvastatin

A nurse is caring for a client who is starting niacin (Naspan) to reduce cholesterol. The nurse should monitor the client for which of the following adverse effects? (Select all that apply)
A) Muscle aches
B) Hyperglycemia
C) Hearing loss
D) Flushing of the skin
E) Jaundice